Midwifery & childbirth, family

Archive for July, 2008

It’s our wedding anniversary today, we have been married for many, many years. In celebration of this feat of perseverance in adversity (!!!) I offer this little montage of facts about life in the 1550’s –

Most people got married in June because they took their yearly bath in May, and still smelled pretty good by June. However, they were starting to smell, so brides carried a bouquet of flowers to hide the body odor. Hence the custom today of carrying a bouquet when getting married.Baths consisted of a big tub filled with hot water. The man of the house had the privilege of the nice clean water, then all the other sons and men, then the women and finally the children. Last of all the babies. By then the water was so dirty you could actually lose someone in it.Hence the saying, Don’t throw the baby out with the Bath water..

Houses had thatched roofs-thick straw-piled high, with no wood underneath. It was the only place for animals to get warm, so all the cats and other small animals (mice, bugs) lived in the roof. When it rained it became slippery and sometimes the animals would slip and fall off the roof. Hence the saying .. It’s raining cats and dogs.

There was nothing to stop things from falling into the house.. This posed a real problem in the bedroom where bugs and other droppings could mess up your nice clean bed. Hence, a bed with big posts and a sheet hung over the top afforded some protection. That’s how canopy beds came into existence.

The floor was dirt. Only the wealthy had something other than dirt. Hence the saying, Dirt poor. The wealthy had slate floors that would get slippery in the winter when wet, so they spread thresh (straw) on floor to help keep their footing. As the winter wore on, they added more thresh until, when you opened the door, it would all start slipping outside. A piece of wood was placed in the entrance way. Hence the saying a threshhold.

In those old days, they cooked in the kitchen with a big kettle that always hung over the fire. Every day they lit the fire and added things to the pot. They ate mostly vegetables and did not get much meat. They would eat the stew for dinner, leaving leftovers in the pot to get cold overnight and then start over the next day. Sometimes stew had food in it that had been there for quite a while. Hence the rhyme, Peas porridge hot, peas porridgecold,peas porridge in the pot nine days old..

Sometimes they could obtain pork, which made them feel quite special. When visitors came over, they would hang up their bacon to show off. It was a sign of wealth that a man could bring home the bacon. They would cut off a little to share with guests and would all sit around and chew thefat..

Those with money had plates made of pewter. Food with high acid content caused some of the lead to leach onto the food, causing lead poisoning death. This happened most often with tomatoes, so for the next 400 years or so, tomatoes were considered poisonous.

Bread was divided according to status. Workers got the burnt bottom of the loaf, the family got the middle, and guests got the top, or the uppercrust.

Lead cups were used to drink ale or whiskey. The combination would sometimes knock the imbibers out for a couple of days. Someone walking along the road would take them for dead and prepare them for burial. They were laid out on the kitchen table for a couple of days and the family would gather around and eat and drink and wait and see if they would wake up. Hence the custom of holding a wake.

England is old and small and the local folks started running out of places to bury people. So they would dig up coffins and would take the bones to a bone-house, and reuse the grave. When reopening these coffins, 1 out of 25 coffins were found to have scratch marks on the inside and they realized they had been burying people alive. So they would tie a string on the wrist of the corpse, thread it through the coffin and up through the ground and tie it to a bell. Someone would have to sit out in the graveyard all night (the graveyard shift.) to listen for the bell; thus, someone could be savedby the bell or was considered a dead ringer.

One of the women featured in the channel 5 documentary about unassisted birth, Clio, is discussing her choice in The Mail’s “Freebirthing: Is it madness or the ideal way to give birth?”, the article has so far elicited 60 comments, the majority of which are against the idea of a woman giving birth without trained support. Obviously, as a midwife I am going to counsel against an unassisted birth, I would also advise against an unsupported pregnancy, meaning no antenatal care. I know, and have seen too much to take the attitude that Sue (one of the commentators) does ‘ If you listen to your body and you are healthy there should be no reason why you can’t have an unassisted birth, We need to go back to the old days, pregnancy and birth are not illnesses.’ She is right, pregnancy and birth are not illnesses’, but that does not exclude circumstances which are capable of changing an everyday ‘natural’ event into a life threatening emergency. I remember that fact EVERY time I am called to a homebirth and EVERY time I conduct a routine antenatal examination. Sue wants us to go back to the old days. What ‘old days’ would those be? The days when women died from eclampsia; haemorrhage; puerperal fever, ruptured uterus when babies died or were damaged by obstructed labour, cord prolapse, undiagnosed twins, locked twins?

So, I’ve let my feelings known, now I’m going to present an example of unassisted childbirth that happened recently. The woman is at term, uncomplicated second pregnancy, apart from her requiring much debriefing about her last labour and birth and a meeting with the anaesthetist to attempt to discover why her last epidural hadn’t worked and an assurance that she would be offered an epidural as soon as she goes into hospital this time. On the day of the birth she as a ‘show’ in the morning and is experiencing slight lower, back pain. Early afternoon saw her having painful tightenings, she sent her husband off to buy a few groceries, he was gone half an hour. He returned to find her on all-fours, telling him that the baby was coming. He insisted they get into the car to go to the hospital, she describes being on the pavement, on her hands and knees, unable to move. He somehow got her into the car, and off they went on a 10 mile drive. A mile from the hospital, stopped at traffic lights in the town centre, she told him the baby was coming, her waters broke and baby’s head started to come. He pulled over, leapt out of the car, asked a group of teenagers to call an ambulance, pulled off his wife’s trousers and baby was born into her underwear. After a struggle with baby and it’s cord, which was tangled in her undies, he gave the baby to his wife. She describes how terrified she was, as initially the baby was ‘floppy’ and didn’t cry, but then she hugged it hard and he cried. They cancelled the ambulance and drove the mile to the maternity unit where Mum had a couple of stitches to a small tear, cord blood was taken, as she was rhesus negative, and they then got back into the car and drove home. When I saw them the next day they were both ‘on a high’. Basically they, especially her, view the experience as being, eventually, better than the birth of their first baby but terrifying at the time. I asked if they would deliberately have an unassisted birth. NO! Would they have a midwife attended homebirth? Not too sure as those seconds, where they thought that the baby was not breathing, made them realise how unpredictable events could be.

Not freebirthing, in fact very much the opposite as Mylene Klass is someone who had private antenatal and birth care. Now though she is outraged at the lack of care she received after the birth of her baby . I have a few thoughts about this, many contradictory. My overall thoughts are that I can’t defend the lack of care she received from the NHS but…..why did she choose to rely on the NHS for her postnatal care having gone privately during her pregnancy and birth? Was it because her private hospital does not provide a domiciliary service, however much you pay and she would have had to go to a clinic for her and baby to be seen?

I’ve had a lovely day, gardening. As I mow, edge, prune and weed my mind wanders from conundrums such as; how does a spider weave a web between the parasol and a tree which are 8ft apart to do ducks eat duckweed? As my thoughts meandered around how could I obtain enough money to give up work I pondered on the jail sentences for John and Anne Darwin, the ‘canoe’ couple from Seaton Carew (just love that placename). Six years, my initial reaction was ‘that’s not too long’, but then I began comparing it to other publicised cases, hit and run drivers who kill and are given 20 month sentences, drunk drivers who kill and receive 4 1/2 years, actually, in the scheme of things, 6 years is quite a hefty jail term when compared to some given to those who have killed. What did the Darwins do? Terrible the deception for their sons, wicked the call-out of the lifeboat, air/sea rescue and the waste of the police time but did they kill anyone? No. They defrauded insurance companies, they are made an example to the rest of us. Unfortunately the message I have decoded is that the courts regard deception as worse than taking a life.

I’m getting really, really angry, wound-up and frustrated with V. In Down Time and other entries I have recounted the problems I have encountered with a certain media company, the latest headache has been their fondness for overcharging, via direct debit, and then not repaying the monies. When I pointed out their error they promised repayment of £120 in March, it never came. They then overcharged again, and then again, the amount they owe is now £160, verbally they promised a cheque, no show. I e-mailed them, in writing they promised the £140 within 7 days, that was 14 days ago. I can just imagine the type of correspondence that I would be in receipt of if I was 4 months late in paying them. The problem is that I am so wound up now that I just want to yell at someone, it is like trying to fight smoke though. They have stolen money from me. Initially it may have been an error, they have acknowledged their error. they have assured me that my money will be returned to me, they have not done it. There is probably some legal term for this, some type of fraud perhaps, little old me just regards it as theft.

“Following the Channel 5 programme broadcast 9 July 2008 (Extraordinary People – Outlaw Birth) featuring three women in the UK and the USA who opted to give birth unassisted at home, the NMC would like to clarify the following points.

Legal position
In the UK it is legal to give birth at home without any professional or medical help.

However, it is illegal for an unqualified, unregistered person to perform the role of a doctor or midwife during the birth.

Standards and resourcesAs part of their training, all midwives are taught that they must

Work in partnership with women to facilitate a birth environment that supports their needs.

Provide care that is delivered in a warm, sensitive and compassionate way.

The Midwives rules and standards states that a midwife

Should respect the woman’s right to refuse any advice given

The Code states that

You must listen to the people in your care and respond to their concerns and preferences

In addition, a recent report from the Royal College of Obstetricians and Gynaecologists (RCOG) states that

Women who choose a home delivery as their birth option should be supported in that choice, appropriate to the level of clinical risk.

Responsibility
In a free birth situation, the mother-to-be takes full responsibility for the birth of her baby.

The mother may choose to have any friend, partner or relative present at the birth.

They may support the mother emotionally but it is not legal for them to assist her in the birth or take any kind of responsibility for the successful outcome of the birth.

Midwives must respect a woman’s decision to have a free or unassisted birth.

The Code and NMC Midwives rules and standards require midwives to be supportive and not be judgemental or critical of this choice.

If midwives have any concerns at all about the woman’s decision, they must address them to their Supervisor of Midwives.”

Well, that’s made it all very plain. I think! Support her choice, be non-judgemental, contact my Supervisor of Midwives if have any concerns about her choice. Ummm, if I’m supporting her and being non-judgemental then going to my Supervisor could be perceived by a woman as obstructive and judgemental. Oh well. All I can say is, as I said here, if you thinking about it then please don’t just read the legal stuff and DIY sites on the web, there are a lot of sites out there with enthusiastic people who mean well but can be somewhat blinkered when it comes to the nitty-gritty. Talk to your midwife, see if a compromise can be reached, most of us don’t want to be ‘in control’, we would just like to try and help you, and your baby, have a positive, safe birth.

Last night was nieces 21st birthday party, at a club, in that well known hub of youthful exuberance and soulful poetry, Milton Keynes. I was really looking forward to the event as it had all the ingredients for an entertaining evening; family, music, dancing, food, with a little soupscon of adrenaline as I had to give a speech and, my sister’s 2 ex-husbands plus her partner would be there.

First, back to Thursday. I had a relaxing day planned. Little pile of ironing to wade through, whilst catching up on some daytime TV, Fern is not the bubbly personality she was since losing all that weight. Not only are her measurements smaller, her warm personality has diminished as well. Shame, she and Phillip were a great ‘cheer-you up’ team. After the ironing a dabble in baking, used up some past it’s best bread and made 2 bread puddings, love the smell of the mixed spices, and then a trip to the hairdressers to have the barnet cropped for the party last night.

Thursday tea-time my job-share phoned to update me on work happenings and issues relating to our caseload. At her clinic one of our woman, booked for a homebirth, had attended for a stretch and sweep , it was unnecessary as C’s cervix was already 5 cms dilated and the membranes were bulging! Good news, as hopefully this means that labour will start quite shortly. Job-share had told C that she would go on call for her and I told my job-share that if there were problems with 2nd midwives, or things were happening very quickly, then she could call me as I only live 5 minutes away from C.

Thursday evening Son came around, he is still having a flare-up of his ulcerative colitis and they have now started him on azathioprine which is, at the moment, not helping. This flare-up has been going on for months now, he has become really anaemic and that, combined with his recent 2 stones weight loss and the constant discomfort is making him really lethargic and quite depressed. I tried to buoy him up, the new drug takes time to work and we will just have to hope that by the time baby arrives he will be full of energy and able to fully enjoy life again. I am worried about him and so a combination of ‘maternal distress’, the old night sweats and restless legs saw me wandering the house when I should have been sleeping. I was just standing on the tiles in the kitchen, good for cooling off and alleviating restless legs, when the phone rang. As I grabbed it quickly so as not to disturb Hubby I glanced at the clock, 2.45 am. It was job-share, C was labouring but……..the doors to the hospital where the on-call equipment is kept were locked, the porter was not responding to her knocking and both the on-call midwives were out at 2 other homebirths. Having experienced difficulty in gaining access before I had the phone number for the porter so relayed that to her and told her to phone me when she needed me. I got back into bed, was just entering that lovely dream-like state which precedes sleep, when she phoned again, would I join her at the homebirth? I left a note for Hubby just in case he woke up and realised I had abandoned him, phoned labour ward and told them what was going on, grabbed my on-call equipment and nipped off down the road. It was all fairly peaceful. C was smiling between contractions, she was really happy to have 2 midwives there who she knew, her previous hospital birth had been quite traumatic as she felt that the midwives were unfriendly and unsupportive, and all progressed quite smoothly to the birth of a little boy at 6am. By the time we had waited for the placenta, it was a physiological third stage so lasted 40 minutes, tidied up all our equipment, weighed baby and checked him over and then helped C with a bath it was 8.345am before we left. I arrived home, my note was still where I left it so I added the request to wake me at 12 noon and, being shattered, I headed for bed, Hubby was just getting up. ‘Bloody hell. Who was phoning at that time?’ was his greeting. I explained who, what and why and it dawned on him that I had been, gone and returned whilst he was sleeping. ‘You’re on annual leave’ was his comment as I snuggled down and hoped I could sleep. I just love that getting into bed after a night-shift or a call-out. The naughtiness of deliberately getting into bed whilst everyone else is just starting their days activities, the knowing that when you awake it will be the same day and you will still have hours to do things in, like go to a 21st party, it’s almost like gaining extra time in your life.

The party. Well, for all my eulogising about how wonderful losing a night’s sleep can be, I feel that age is catching-up with me and I don’t recover as well so I was possibly less energetic than I had hoped. My niece looked lovely and really, really enjoyed herself. The speeches were lovely, I did a tongue-in cheek imitation of an M & S advert, you know, using the ‘ extra-sweet, hand-dusted, steeped, traditional, 21 year-matured’ keywords, I think it was appreciated (the 3 bacardi’s and no food helped)! I did very little dancing, the music was good but really not suited to a 50 year-old trying out her moves in front of a room full of mainly 20 year olds. My Mother, the ********** , use any expletive descriptive of pure evil here, did her usual and behaved similarly to how she had at Son’s wedding, controlling and attention-seeking. Hubby ended up having to drive her home as she wouldn’t take a taxi. At one point, after being introduced to her grand-daughter’s fiancees relatives she said ‘ Well, of course R’ (her husband) ‘has bi-polar’, attempting to lighten the conversation I interjected with ‘Yes, he’s big and white with a black nose’, she rejoined with how she diagnosed his condition, instructs the doctors on the medication he requires, and then she decides regimes and dosages. Apparently, if it wasn’t for her R would be dead, if it wasn’t for her he would be mentally stable, is my observation. At the party my previous, and present brother-in-laws all behaved impeccably toward each other. One of them I hadn’t seen for about 15 years, it was good to catch-up. When there is a divorce it is an odd situation for other family members. There you are, all a family together, sharing so many parts of your lives and suddenly this quite major member of the family disappears off the radar, this huge chunk of family life disappears. (Huge chunk is not meant to imply that either of my ex-BIL’s are overweight!) We left at 12.30, Hubby was sober and in danger of being deafened by the music, I was tired, tired and tipsy. After several failed attempts, frequent muliple revolutions of roundabouts, we left Milton Keynes, headed into Bedfordshire, had a passing aquaintance with the M1, a close encounter with Whipsnade Zoo and eventually got home at 2.30am. Hubby insists that at no time did he take a wrong turning, he was just enjoying listening to Leonard Cohen

At my house I have a little perspex chest which is full plastic of bead necklaces, bracelets, clip-on earrings and decorative hair clips, Amy loves it. Today she was playing with the contents and had festooned herself with lots of the necklaces. The time came for me to take her home and look after her and the boys whilst their Mummy had a break, I didn’t bother to remove them before we headed out. Whilst at their house she removed the jewellery, I put all the necklaces around my neck to stop the boys from eating them, and promptly forgot about them. On the way home I stopped to pick-up some shopping. I wandered happily around, smiling at everyone who looked at me, and lots of people did look! When I got home I saw the perspex chest and realised I had just set a new fashion trend, multiple, plastic, variously coloured, plastic necklaces.